Over-the-Counter Drug Listing

[Pages:2]Over-the-Counter Drug Listing

Over-the-Counter Drugs Used Primarily for Medical Care. These items are reimbursable with only a thirdparty receipt (the name of the medication and the purchase date must be on the receipt.) No recommendation from a health care provider is required.

Type of Drug

Examples1

Allergy Prevention & Treatment

Benadryl, Sudafed, Actifed, Claritin, Chlora Trimaton, Nasalcrom

Antacids and Acid Reducers

Gas-X, Maalox, Mylanta, Tums, AXID AR, Pepcid AC, Prilosec OTC, Tagamet HB, Zantac 75

Anticandial Antihistamines

Fenstat 3, Gyne-Lotrimin, Mycelrx-7, Monistat 3, 7, Vagistat-1

Actidil Syrup and Capsules, Actifed, Allerest, Benadryl, Claritin, Chlor-Trimeton, Contac, Dimetane, Drixoral, Nyquil, Sudafed, Tavist-1, Triaminic

Antidiarrheal and Laxatives

Ex-Lax, Pepto-Bismol, Immodium A.D., Kaopectate

Anti-fungal

Lamisil AT, Lotramin AF, Micatin

Anti-itch Lotions and Creams (e.g., for athletes foot, Bactine, Caldecort, Cortaid, Hydrocortisone, Lanacort,

jock itch, bug bites, poison ivy)

Calamine Lotion, Benadryl Cream, Caladryl

Asthma

Primatene Mist

Cold Sore/Fever Blister

Abreva Cream, Carmex

Condoms and Other Contraceptive Devices

Trojans, Magnum, VGF Film, Delfen Contraceptive Foam

Contact Lenses Solutions Cough Suppressants

Bausch & Lomb, Renu, Aosept, Allergan, Boston, OptiFree

Robitussin, Vicks 44, Chloraseptic

Decongestant/ Nasal Decongestant and Cold Remedies

Diaper Rash Ointments

Advil Cold and Sinus, Afrin, Afrinol, Aleve Cold and Sinus, Children's Advil Cold, Duration, Dristan Long Lasting, Neo-Synephrine-12 Hour, Orrivin, Pedialyte, Sudafed, Tavist-D, Tylenol Cold and Flu, Thera-flu, Alka Seltzer Cold and Flu

Balmax, Desitin

Eye Drops for Allergy/Cold Relief

Ocu Hist

First Aid Supplies Hemorrhoid Treatments

Ace Bandages, Band-Aids, Bandage Tape, Thermometers, Medical Gloves, Gauze, Neosporin, Rubbing Alcohol, Visine

Preparation H, Hemorid, Tronolane

Internal Analgesic/antipyretic

Incontinence Supplies Liniments

Advil, Aleve, Children's Motrin, Nuprin, Excedrin, Tylenol, Bayer

Depends BenGay, Tiger Balm, Flexall

1 This list is not an exhaustive list and is intended to give examples of some of the most common brand names of OTC drugs.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE? Managed Care, Inc. (RIT), Healthy Alliance? Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (excluding the City of Fairfax, the Town of Vienna and the area east of State Route 123.): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ? ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

AT 0039 200909

Medical Monitoring

Services and Bracelets specifically for medical information

Medical Products and Devices

Blood Pressure Monitor, Glucose Tester, HIV Test, Cholesterol Test, Diabetic Supplies, Crutches, Ovulation Monitor, Pregnancy Testing Kits

Menstrual Cycle Medications

Midol, Pamprin, Premysyn PMS

Migraine

Advil Migraine Liqui-gels, Excedrin Migraine, Motrin Migraine Pain

Motion Sickness Medication

Dramamine, Marizine

Nicotine Gum / Patches and Smoking Cessation Aids

Commit, Nicoderm CQ, Nicorette, Nicotrol, Nicodin

Pediculicide (head lice)

Nix

Poison Ivy Protection

Ivy Block

Sleep Aids

Tylenol Simply Sleep, Unisom Sleep Tabs, Sominex, Sleepinal

Toothache and Teething Pain Relievers

Orajel

Wart Removal Medications

Tinamed

Dual Purpose OTC Drugs. These items require a third-party receipt and a note from the health care provider

listing the diagnosis of the medical condition and the recommendation of the OTC Drug.

Anti-baldness/ hair loss/ hair replacement/ such as Rogaine, but only if to replace hair loss due to a medical condition (e.g. cancer treatment) and not for balding due to age

Fiber supplements such as Benefiber and Metamucil

Glucosamine/Chondrotin for arthritis or other medical condition (not reimbursable if taken for overall joint health)

Herbal supplements used to treat a specific disease such as St. John's Wort for depression Hormone Therapy Drugs Medicated shampoos to treat a specific medical condition like psoriasis (only the amount in excess of the cost of normal shampoo is reimbursable.) No Doz (and other sleep prevention drugs)

Nose strips for proper breathing or other medical conditions

Retin-A and other acne medicines (not reimbursable if used for cosmetic purposes such as wrinkle reduction)

Snoring cessation aids and medications such as Breathe Right Spray, Snorezz

Sunscreen and Sunblock

Vitamins are not an eligible expense, unless prescribed by a physician to treat a specific medical condition. (i.e. Iron to treat, not prevent, anemia; Calcium supplements to treat, not prevent, Osteoporosis). A doctor's note detailing the specific medical condition will be required for reimbursement

Weight loss/dietary supplements must be for a specific medical condition such as obesity OTC Items Not Reimbursable. These items are obtained for cosmetic, personal, or general health purposes and are not reimbursable.

Chapstick Cosmetics Cotton balls Deodorants Face creams, moisturizers, eye creams, and wrinkle reducers

Feminine hygiene products such as tampons and maxi pads

Food items (i.e. Slim Fast)

Hair removal treatments and waxes

Mouth washes, antiseptics and oral anesthetics

Shaving cream and razors Soap Teeth whitening kits and powders Toothpaste Vitamins taken to improve overall health

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE? Managed Care, Inc. (RIT), Healthy Alliance? Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (excluding the City of Fairfax, the Town of Vienna and the area east of State Route 123.): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ? ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

AT 0039 200909

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